Introduction: Internal rotation contractures secondary to birth palsy frequently lead to glenohumeral deformity. Treatment recommendations range from open release to primary latissimus dorsi transfer. This is a report of 26 arthroscopic contracture releases with F/U ranging from 2 to 3.5 years.
Methods: Arthroscopic contracture releases were performed on 26 children, aged 0.8 to 12 years. Older children (mean age 7.3 years) also received a latissimus dorsi transfer; younger children (mean age 1.6 years) only a release. Pre-operative passive external rotation averaged –33° and 0° for the two groups, respectively. Eleven children received a latissimus transfer in addition to a release, 15 a release only. Pre-operative arthrograms were done in all cases, MRIs in 24.
Results: Arthroscopic release was successful in achieving passive external rotation and a centered position of the glenohumeral joint at the time of surgery in all but one case, the oldest child with severe deformity. At follow-up the average increase in external rotation was 86°for the latissimus transfer group and 55° for the release group. The average gain in elevation was 7°. Internal rotation averaged between L4 and L5. Four of the children who had an isolated release developed a recurrent contracture requiring additional releases and latissimus transfers. None of the children that had a latissimus transfer developed a recurrent contracture. MRI at 2-year's follow-up showed reversal of pre-operative deformity in all but one child, again the oldest child.
Conclusions: Arthroscopic release is effective in achieving passive external rotation. Most young children have sufficient external rotation strength at early follow-up to maintain a centered glenohumeral joint and normalize glenoid development. Improvements in elevation are modest and loss of internal rotation is common.